Oral versus i.v. antibiotics for community-acquired pneumonia in children: a cost-minimisation analysis

Abstract

Community-acquired pneumonia represents a high financial burden to healthcare providers. This manuscript seeks to estimate and compare the costs of treating children hospitalised with community-acquired pneumonia, with oral and intravenous antibiotics, thus determining which treatment is cost minimising.A cost-minimisation analysis was undertaken alongside a randomised controlled non-blinded equivalence trial. 232 children (from eight paediatric centres in England) diagnosed with pneumonia, who required admission to hospital, were randomised to receive oral amoxicillin or i.v. benzyl penicillin. The analysis considered the cost to the health service, patients and society, from pre-admission until the child was fully recovered.Oral amoxicillin and i.v. benzyl penicillin have equivalent efficacy. Children treated with i.v. antibiotics were found to have significantly longer in-patient stays (3.12 versus 1.93 days; p,0.001). i.v. treatment was found to be more expensive than oral treatment (£1,256 versus £769; difference £488; 95% CI: £233-£750), such that treatment of community-acquired pneumonia with oral amoxicillin would result in savings of between £473 and £518 per child (J545 and J596 per child) admitted.The findings demonstrate that oral amoxicillin is a cost-effective treatment for the majority of children admitted to hospital with pneumonia.

Assessment of the pattern of antibiotics use in pediatrics ward of Dessie Referral Hospital, North East Ethiopia

“…Some infections (for example, central nervous system infections) or patients groups (for example, neonates and infants) require parenteral use. Feleke et al (2013) reported higher administration of parentral antibiotics (81.8%) in bishoftu, Woldu et al in hawassa (93.6%), Kanish et al(92%) and Sviestina and Mozgis in lativia (64-86%).The finding in this study though relatively good, still should be discouraged and switch to oral medications when there is indication must be practiced because can reduce stay at the hospital, decrease the risk of needleborne infections like HIV/AIDS and hepatitis and can decrease administration and family-related costs (Rojas and Granados,2006;Lorgelly et al, 2010;Vouloumanou et al, 2008).…”

Antimicrobial usage among hospitalized children in Latvia: A neonatal and pediatric antimicrobial point prevalence survey

“…Alternatively, some oral antibiotics are not available on the Latvian market, e.g., flucloxacillin and penicillin Whilst some infections (e.g., central nervous system infections) or patients groups (e.g., neonates) require parenteral use there are other patient groups (e.g., children, adolescent) and/or diagnoses where the disproportionately high use of intravenous antibiotics should be reduced at hospitals in Latvia. In some situations (e.g., community acquired pneumonia or some cases of acute pyelonephritis), switch to oral antibiotics allow reducing the stay at the hospital and has potential benefits because can decrease the risk of needle-borne infections, need for referral or admission, administration costs, and family-related costs [23][24][25]. Our results are similar with the study done in pediatric antimicrobial prescribing in 32 hospitals of 21 European countries where parenteral route was more commonly used than the oral route for both prophylactic and therapeutic indications [12].…”

Increased paediatric hospitalizations for empyema in Australia after introduction of the 7-valent pneumococcal conjugate vaccine

“…On the other hand, the reduction in pneumonia admissions has saved the health system US$ 3.8 million-6.1 million annually (based on United Kingdom cost-analysis data for pneumonia admissions). 31 Although modest, the additional costs owing to the increase in cases of empyema among children would be reduced by the use of a vaccine with broader pneumococcal serotype coverage. 3 In July 2011 (October 2011 in Australia's Northern Territory), Australia's 13-valent pneumococcal conjugate vaccine was introduced into the national immunization programme.…”